Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
J Gastrointest Surg. 2011 Feb;15(2):345-9. doi: 10.1007/s11605-010-1342-4. Epub 2010 Sep 8.
The (99m) technetium labelled hepato imino diacetic acid (HIDA) scan is widely used in the investigation of patients with typical biliary pain but whose trans-abdominal ultrasound scan (US) is normal. Although the standard measure by which the HIDA scan is deemed positive is the presence of an ejection fraction (EF) of <35% following provocation with cholecystokinin (CCK), there still remains debate as to the usefulness of this measure. The aim of this study was to compare the roles of EF and symptom provocation following CCK infusion in relation to the outcome following laparoscopic cholecystectomy (LC). More specifically, we aimed to review the resolution of symptoms for our significant population of patients with normal HIDA scan EFs for whom surgery has traditionally been deemed inappropriate.
All patients undergoing LC for a presumed diagnosis of biliary dyskinesia were identified from a prospectively maintained database. Data were collected regarding pre-operative symptoms, EF and symptom provocation during the CCK HIDA scan, histological findings, early symptomatic outcome, and medium-term follow-up.
During the period from March 2006 to October 2009, 42 patients with biliary symptoms but a negative US were referred for assessment by a single surgeon. There were 31 women and 11 men with a mean age of 39.0 ± 12.6 years. All underwent a CCK HIDA scan of which 17 were positive with an EF <35% and the remaining 25 were negative. All patients reported recreation of symptoms following administration of CCK. All gallbladders were delivered intact for histological assessment and all but one showed evidence of chronic cholecystitis. At each postoperative visit, approximately 2 weeks following the procedure, all patients reported resolution of symptoms. After a mean of 18.7 ± 12.1 months symptom recurrence had been noted in only one of 42 (2.4%).
The CCK HIDA scan is a useful study in the investigation of acalcalous cholecystitis; however, we would suggest that recreation of symptoms following CCK provocation is superior to EF for the identification of underlying chronic cholecystitis. Indeed, a normal gallbladder ejection fraction does not necessarily rule out a biliary aetiology of symptoms for this patient population.
（99m）锝标记的肝亚氨基二乙酸（HIDA）扫描广泛用于有典型胆绞痛但腹部超声（US）正常的患者的检查。尽管刺激胆囊收缩素（CCK）后 HIDA 扫描被认为阳性的标准测量是射血分数（EF）<35%，但对于该测量的有用性仍存在争议。本研究的目的是比较 EF 和 CCK 输注后症状激发在腹腔镜胆囊切除术（LC）后的结果中的作用。更具体地说，我们旨在审查我们的重要人群中正常 HIDA 扫描 EF 的患者的症状缓解情况，对于这些患者，传统上认为手术不合适。
从一个前瞻性维护的数据库中确定了所有因疑似胆功能障碍而行 LC 的患者。收集了术前症状、CCK HIDA 扫描时的 EF 和症状激发、组织学发现、早期症状结果和中期随访的数据。
在 2006 年 3 月至 2009 年 10 月期间，有 42 名有胆绞痛症状但 US 阴性的患者被一位外科医生推荐进行评估。有 31 名女性和 11 名男性，平均年龄 39.0±12.6 岁。所有患者均行 CCK HIDA 扫描，其中 17 例 EF<35%为阳性，其余 25 例为阴性。所有患者在给予 CCK 后均报告症状再现。所有胆囊均完整取出进行组织学评估，除 1 例外，其余均显示慢性胆囊炎证据。在术后每次就诊时，即手术后大约 2 周，所有患者均报告症状缓解。在 42 例患者中，平均随访 18.7±12.1 个月后仅 1 例（2.4%）出现症状复发。
CCK HIDA 扫描是一种用于研究非钙性胆囊炎的有用研究；然而，我们建议 CCK 激发后症状再现优于 EF 用于确定潜在的慢性胆囊炎。事实上，正常的胆囊射血分数并不能排除这一患者群体的症状的胆道病因。
